29 April 2022

Knowledge and skills are not enough. Vets must have access to essential medicines

Dr Shereene Williams, Global Animal Health Advisor at Brooke, discusses the difficulties vets face in accessing essential medicines and how Brooke is working for change.

An Agro-Vet shop in Kenya (left), Dr Shereene Williams with a horse (right)

ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care. (Royal College of Veterinary Surgeons oath)

Similar words have been declared by every veterinarian around the globe, yet what about when this is not possible. What then?

During my last visit to Ethiopia, myself and my colleagues Abdi and Melese stood around a gravely injured horse. This horse had been attacked by a hyena and had large and painful wounds over his hind quarters that were now crawling with maggots. As vets at Brooke, we are used to practising veterinary medicine within a rural low resource setting and working with owners who rely on their animals to make a daily wage. In spite of this experience, in this moment we were all reduced to tears. This horse needed a sedative, pain relief, to have his wounds cleaned and debrided, antibiotics and ongoing care from his owner and local vet. Humane euthanasia was also a consideration as this animal had been and would continue to suffer greatly.

Yet we had no access to these medicines. Not one of them.

In a recent survey of vet professionals conducted by Brooke and the World Veterinary Association, 80% of respondents felt their ability to address animal health was restricted due to issues in accessing essential veterinary medicines and vaccines.

That day in Ethiopia, we did the best that we could by cleaning the wound and administering an antibiotic that is more appropriate for cows and sheep and then used paracetamol from our own first aid kits in order to provide some pain relief. That animal’s injury was grave and our treatment was sub-standard. He needed more from us.

For all the skill and knowledge that existed in the three veterinarians stood around that horse, in that moment it did not matter as skills and knowledge alone cannot ease suffering or ensure health and welfare of animals.

Here in the UK, we are used to having choice for our animals. We may have a preferred wormer or flea treatment based on price, size or even how tasty we think our animals find it. Equally, as a vet we often have preferred products; ones that we trust more or find easier to use. Yet for our veterinary colleagues around the globe, life is very different.

Brooke’s survey with the World Veterinary Association received responses from more than 700 veterinary professionals from 36 countries. The results are stark; almost a quarter of respondents felt that issues in accessing essential veterinary medicines greatly restricted the ability of vets to address animal health needs. 15% do not have access to pain relief and 34% mentioned a lack of access to vaccines for foot and mouth, tetanus and rabies.

More than a third of respondents did not have access to medicines they needed in order to be able to perform humane euthanasia.

Whether it is preventing disease, relieving pain or trying to give an animal a dignified painless death, vets around the world are held back by their difficulties in accessing essential veterinary medicines. As my colleague Melese put it, we are trying to do our jobs with one hand tied behind our back.  

Veterinary medicines also matter to more than just vets and animals, they matter to people and to the environment.

There is no doubt that the misuse of antimicrobials within the global veterinary sector is contributing to growing resistance and has a part to play in the rising human death toll from resistant bacterial infections. Faced with poor access or poor regulation of antimicrobials, vets and owners are making poor decisions and resistance is building.

Additionally, animal products form a crucial part of billions of people’s diets and livelihoods, with veterinarians being responsible for ensuring those products are safe. Inappropriate use of medicines or lack of access to essential vaccines threaten the human food chain.

We also know that 75% of emerging diseases have an animal origin and 60% of infectious human diseases are zoonotic. Therefore, preventing disease in animals through vaccination and quality health care is essential for human health.

Veterinary medicines also have a big impact on the environment, as highlighted by the Asian vulture crisis which has seen multiple species of vulture near extinction due to the use of diclofenac in livestock.

So what can be done?

Brooke is partnering with the World Veterinary Association to create the first essential veterinary medicine list for livestock. This project has utilised global expertise to build an evidence based model list that includes medicines and vaccines for eight food producing species including working equids. The list that will be published later this year aims to form a blueprint for countries to build their own context specific lists. This is a critical first step in determining the true global availability of veterinary medicines and supporting veterinarians around the globe to prioritise and advocate for improved access.

Brooke also works with local organisations and national governments to highlight these challenges. Our team in Ethiopia are spearheading an innovative approach to the long standing issue of unavailability of veterinary medicines. They have formed a working group that includes government representatives, local academic institutions, veterinary drug and feed association and secured a formal commitment from all to work together on this critical issue.

As well as this, Brooke is present on the ground, working with more than 6000 animal health service providers including veterinarians and agro-pharmacists. Our unique mentoring programme sees our specialised staff train and mentor those using veterinary medicines and those selling veterinary medicines. We take our training out of the classroom and into the field where we know that it is most needed and provide one to one support to practitioners helping them to make correct diagnosis and ensure effective treatment choices. This also helps us capture real time data on the medicines being used by vets every single day all over the globe. 

Brooke also works with communities to ensure that owners are seeking veterinary services from trained practitioners and buying medicines from reputable pharmacies, steering them away from traditional healers and black market products.

The scale of the issue goes beyond Brooke. We desperately need international human and animal health organisations, national governments and the global veterinary community to recognise the impact that this is having on animal health and welfare around the globe and commit to work together to improve this situation.

So on this World Vet Day, let's all commit to ensuring vets have everything they need - not just the knowledge and skills but also the vital, essential medicines. When fully equipped, we can fulfil our oath and relieve the pain and suffering for animals everywhere.